Advances in surgical treatment of acute and chronic coronary artery disease. Tex Heart Inst J

Minimally Invasive Surgical Technology, Texas Heart Institute, St. Luke's Episcopal Hospital, Houston, Texas 77030, USA.
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital (Impact Factor: 0.65). 06/2010; 37(3):328-30.
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    • "Psychosocial factors such as anxiety, depression, negative affectivity, and social inhibition are measurements that can potentially relate psychological phenomena to the social environment and to pathophysiological changes [1]. Symptoms of anxiety and depression are common psychological disturbances among patients with coronary artery disease, including those undergoing coronary artery bypass graft (CABG) surgery [2], which is an effective therapy for prolonging life and decreasing symptoms in appropriately selected patients [3]. Previously, we showed that patients with high preoperative anxiety have a significantly higher mortality rate four years after surgery [4]. "
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    ABSTRACT: Background Psychosocial factors have shown independent predictive value in the development of cardiovascular diseases. Although there is strong evidence to support the role of psychosocial factors in cardiovascular mortality, there is a scarcity of knowledge about how these factors are related. Therefore, we investigated the relationship between depression, anxiety, education, social isolation and mortality 7.5 years after cardiac surgery. Methods After informed consent, 180 patients undergoing cardiac surgery between July 2000 and May 2001 were prospectively enrolled and followed for ten years. During the follow-up period, the patients were contacted annually by mail. Anxiety (Spielberger State-Trait Anxiety Inventory, STAI-S/STAI-T), depression (Beck Depression Inventory, BDI) and the number and reason for rehospitalizations were assessed each year. Those patients who did not respond were contacted by telephone, and national registries were searched for deaths. Results During a median follow-up of 7.6 years (25th to 75th percentile, 7.4 to 8.1 years), the mortality rate was 23.6% (95% confidence interval [CI] 17.3-29.9; 42 deaths). In a Cox regression model, the risk factors associated with an increased risk of mortality were a higher EUROSCORE (points; Adjusted Hazard Ratio (AHR):1.30, 95%CI:1.07-1.58)), a higher preoperative STAI-T score (points; AHR:1.06, 95%CI 1.02-1.09), lower education level (school years; AHR:0.86, 95%CI:0.74-0.98), and the occurrence of major adverse cardiac and cerebral events during follow up (AHR:7.24, 95%CI:2.65-19.7). In the postdischarge model, the same risk factors remained. Conclusions Our results suggest that the assessment of psychosocial factors, particularly anxiety and education may help identify patients at an increased risk for long-term mortality after cardiac surgery.
    Full-text · Article · Sep 2012 · Journal of Cardiothoracic Surgery
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    ABSTRACT: Over the past decade, minimally invasive cardiothoracic surgery (MICS) has grown in popularity. This growth has been driven, in part, by a desire to translate many of the observed benefits of minimal access surgery, such as decreased pain and reduced surgical trauma, to the cardiac surgical arena. Initial enthusiasm for MICS was tempered by concerns over reduced surgical exposure in highly complex operations and the potential for prolonged operative times and patient safety. With innovations in perfusion techniques, refinement of transthoracic echocardiography and the development of specialized surgical instruments and robotic technology, cardiac surgery was provided with the necessary tools to progress to less invasive approaches. However, much of the early literature on MICS focused on technical reports or small case series. The safety and feasibility of MICS have been demonstrated, yet questions remain regarding the relative efficacy of MICS over traditional sternotomy approaches. Recently, there has been a growth in the body of published literature on MICS long-term outcomes, with most reports suggesting that major cardiac operations that have traditionally been performed through a median sternotomy can be performed through a variety of minimally invasive approaches with equivalent safety and durability. In this article, we examine the technological advancements that have made MICS possible and provide an update on the major areas of cardiac surgery where MICS has demonstrated the most growth, with consideration of current and future directions.
    Full-text · Article · May 2011 · Future Cardiology
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    ABSTRACT: As in all surgical disciplines, even for cardiothoracic surgery obesity represents a very important factor for patient management, most of all considering the increasing incidence of this condition in the whole population. Obesity may influence all the surgical processes, including the preoperative assessment, the intraoperative phase, and the postoperative period. In the context of thoracic surgery, particular attention should be focused on obesity-related diseases, such as COPD, OSAS, and diabetes, other than pulmonary and cardiac impairment that could strongly influence patient’s perioperative management. Likewise the increased number of obese and extremely obese patients presenting for cardiac surgery has created a particular set of challenges and has spurred efforts to understand and minimize the risks in this cohort. Cardiac surgery performed on obese patients is of increased complexity due to the pathophysiological derangements as well as technical considerations due to the physical dimensions of the patient. The surgical approach must be tailored for the individual patient, aiming to utilize all available technological resources and more appropriate therapeutic strategies in order to improve outcome.
    No preview · Chapter · Jan 2014
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